Transcatheter Closure of Secundum-Type Atrial Septal Defect After Failed Surgical Intervention

Abstract

Atrial septal defect (ASD) closure is routinely performed using transcatheter closure under echocardiographic guidance. A 24-year-old male was evaluated for a newly detected heart murmur. This was the first time a murmur or any other cardiac abnormalities were detected. He reported no symptoms of chest pain, dyspnea, palpitations, and reported being able to run without limitations. Physical examination revealed a short-grade systolic murmur consistent with high pulmonary flow in the left sternal border. A transesophageal echocardiogram revealed a 28-mm secundum ASD with right ventricular and right atrial enlargement. Percutaneous closure device was initially contemplated but was deferred secondary to the size of ASD and the lack of inferior rim. He then underwent open surgical closure, which was complicated by reoperation for bleeding and incomplete ASD closure. However, the surgery provided a new generous inferoposterior rim from scar tissue to perform percutaneous closure. This case illustrates an example of a patient with a significant ASD with an initially inadequate rim to perform a successful percutaneous closure. Following a failed surgical closure, the patient had developed enough scar tissue in the previously inadequate rim to undergo a successful percutaneous closure that resolved his defect.